Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 88888 DEA: SMTL-STOCK EFIS: SMTL-STOCK
QA Service Level:
DIST-CO-RTE-PM: 59---
Work Description: Special project for SMTL stock material. Object Code: 1025. J2 DEA: 912680.
Location Description:
Contractor Name: Unknown
Contractor Address: Unknown
Resident Engineer: Unknown Structure Rep.: Unknown
DIME Sample ID: 2026-04-02-1
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Sacramento Field Office
Sample Organization Contact: (916) 2058871
Type of Sample: Stock
Type of Material: SMTL TM3 - Fastener Assembly
Sample Taken Date: 04/02/2026
Date that the sample was received by the laboratory/organization performing the testing:
The quantity of what the sample constitutes: 500
A brief description of the sample: A449 Bolt
From where was the sample collected: Source
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: KT
Rocap Number(s): -
Heat Number(s): 3112817
Nut Mfg. Lot Number(s): W000278671
Washer Mfg. Lot Number(s): 1025-798
Bolt Specification: A449
Bolt Length(s): 6.00
Nut Specification: A563/A194
Washer Specification: F436
Finish: HDG
Diameter/Size: 0.63
Bolt Mfg. Lot Number: 72207-01
Rocap Test Requirement(s): 0
Lubricant Requirements(s): 0
Washer Inner Diameter(s): 0
